Incarcerated individuals bear a disproportionate burden of HIV, as well as other sexually transmitted infections, chronic disease, and substance abuse and mental health issues. In 2008, 1.4% of prison inmates in the United States was HIV-positive (HIV+), and every year, 1 in 7 HIV+ persons pass through a correctional facility. Following release, their HIV care and outcomes are largely unknown. The purpose of this study is to investigate HIV care and outcomes among newly diagnosed HIV+ individuals arrested or released from jail, prison or juvenile detention (post-incarceration period) within Marion County (Indianapolis), Indiana over a 12-year period. We will use the HIV care continuum conceptualized as a staged or stepped cascade including HIV diagnosis, linkage to care, retention in care, initiation of antiretroviral therapy and viral suppression as a conceptual framework to guide our methodology. The central hypothesis is that HIV+ offenders in the post-incarceration period will have poorer HIV care and clinical outcomes at every stage of the care continuum, compared to prior to arrest or incarceration and compared to HIV+ individuals in the non-offender population. The rationale for this project is to identify new opportunities for improving HIV management along the HIV care continuum among this vulnerable population. In collaboration with criminal justice, clinical and public health agencies serving Marion County, all individual-level arrest, juvenile detention, jail and prison records were linked with positive STI/HIV test results over a 9- year period. Building on this foundation of expertise and resources, the proposed study will incorporate outpatient, inpatient and emergency department encounter, medication and laboratory data over a 12-year period using the Indiana Network for Patient Care system, one of the most comprehensive clinical encounter data sets for a U.S. metropolitan area. These data will give us the unprecedented ability to investigate the HIV care continuum over time among HIV+ offenders in the post-incarceration period as defined by the 12-, 24- and 36-months following release and identify when and how HIV care can be improved for this vulnerable subset of the HIV+ population. The aims are to (1) Assess linkage to care among offenders diagnosed with HIV during and following incarceration; (2) Describe if, when, where and at what frequency recent offenders who are HIV+ receive HIV-related clinical services in the post-incarceration period; (3) Among recent offenders with at least 1 HIV-related clinical visit in a post-incarceration period, assess the quality of HIV care management; and (4) Investigate clinical care outcomes among offenders in the post-incarceration period. The long-term impact of our research is to improve the care and outcomes of HIV+ individuals in the post- incarceration period. Our analyses will inform us when, where, and how best to intervene.